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| Turkish Society of Cardiology Young Cardiologists Bulletin Year: 8 Number: 3 / 2025 |
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Prepared By. Mehmet Altunova Name of th e Study4D-ACS – Shortened DAPT Strategy After Acute Coronary Syndrome Published in CongressEuroPCR 2025 Link https://www.emjreviews.com/interventional-cardiologyIntroduction The optimal duration of dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) undergoing drug-coated stent implantation remains uncertain. The 4D-ACS trial was designed to assess the safety and efficacy of a shortened DAPT strategy. ObjectiveTo evaluate whether 1-month DAPT followed by low-dose prasugrel monotherapy is as safe and effective as standard 12-month DAPT. MethodsIn this multicenter, double-blind randomized trial, 656 East Asian patients with ACS were randomized after PCI with a drug-eluting stent to either the 1M-DAPT group (First month: Aspirin 100 mg + Prasugrel 10 mg [or 5 mg if aged ≥75 years or <60 kg]; following 11 months: Prasugrel 5 mg monotherapy) or the 12M-DAPT group (Aspirin + Prasugrel 5 mg for 12 months). The primary endpoint was net adverse clinical events (NACE) at 12 months, including death, non-fatal MI, stroke, ischemia-driven target vessel revascularization, and BARC type 2-5 bleeding. ResultsNACE occurred in 4.9% of the 1M-DAPT group versus 8.8% of the 12M-DAPT group, demonstrating both non-inferiority and superiority of the shortened regimen. Major bleeding was significantly reduced in the 1M-DAPT group (0.6% vs 4.6%; HR 0.13; p=0.007). Ischemic event rates were similar between the two groups. ConclusionsThese results suggest that a 1-month DAPT regimen followed by low-dose prasugrel monotherapy may offer improved safety without compromising ischemic protection, particularly in patients at high bleeding risk. Limitations and ConcernsThe study was primarily conducted in East Asian populations, so the generalizability of the findings to other ethnic groups may be limited. The sample size was relatively modest, and there are no long-term (>1 year) follow-up data available. The long-term safety profile of low-dose prasugrel monotherapy remains unclear. CommentaryThe 4D-ACS trial highlights the potential for individualized antiplatelet strategies, supporting a safer and more tailored approach to managing ACS.
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